Abstract:

Objective To evaluate the efficacy of brachial plexus block in surgical treatment of tuberculosis of the shoulder joint. Methods 42 patients with tuberculosis of the shoulder joint underwent surgical treatment, who were admitted in Beijing Chest Hospital, Capital Medical University during October 2014 to October 2018, were divided into group A (n=23, brachial plexus block plus general anesthesia) and B (n=19, general anesthesia only). There were two cases were excluded in group A due to one case with cervical lymph node tuberculosis and another case with failure of brachial plexus block. The heart rate (HR) and mean arterial pressure (MAP) were recorded before skin incision and at the time of incision. The intraoperative infusion rate of propofol was regulated under the guidance of BIS. The use of remifentanil and nicardipine were recorded. The numerical rating scale (NRS) of pain and the dosage of opium at 6 hours, 24 hours after operation were recorded. Results The MAP and HR at skin incision ,and the rate of use of antihypertensive drug in group A were significantly less than those in group B ((75.6±10.7)mm Hg and (88.2±10.0)mm Hg (1mm Hg=0.133kPa), (75.1±13.6)bpm and (80.9±14.8)bpm, 14.3% (3/21) and 52.6% (10/19), respectively (t=3.816,P=0.000;t=2.166,P=0.037;χ ²=6.686,P=0.017)). The dosage of remifentanil,the NRS pain score in 6h after operation and the dosage of opium in 6h and 24h after operation in the group A was significantly lower than those ((0.4±0.1)mg and (0.7±0.1)mg, (9.1±0.3)ml and (12.0±1.6)ml, (1.7±1.2) and (3.3±1.1), (38.4±4.1)ml and (42.7±5.8)ml) in the group B (t=10.364, P=0.000; t=2.845, P=0.010; t=4.921, P=0.000; t=2.650, P=0.013). Conclusion Brachial plexus block plus general anesthesia can reduce of the blood pressure fluctuation during skin resection and the dosage of antihypertensive drugs and opioid drugs during the operation of shoulder tuberculosis. It is important for the smooth implementation of the operation and postoperative analgesia and rehabilitation.

Key words: Tuberculosis, osteoarticular, Surgical procedures, operative, Anesthesia, local, Anesthesia, general, Anesthetics, combined, Comparative study